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Pediatricians urged to screen infants and toddlers for signs of 'toxic stress'

Physician's assistant Erin Frazier checks a young boy at a community health center for low-income patients in Lakewood, Colorado. The American Academy of Pediatrics will soon announce recommendations for pediatricians and their staffs on spotting signs of "toxic stress" in infants and toddlers. (Photo by John Moore/Getty Images) John Moore/Getty Images

With growing awareness in the field of infant mental health, based on the deepening body of scientific evidence, experts agree that monitoring babies for healthy brain development will lead to better longer-term outcomes.

AAP's recommendations are similar to previous warnings to shield children from second hand cigarette smoke or too much video screen time. This time, AAP is looking at how stress can impact a baby’s development.

If these occur frequently in a baby’s life, Levitt warns there will be “short term [and] long term problems.” Extremely stressful events a baby faces might be abuse or neglect, food insecurity, or even maternal depression, according to Levitt.

When a developing infant brain is constantly exposed to stressful events or trauma, Levitt says the brain cannot “filter out powerful bad experiences from powerful good experiences.” He adds that the accumulation of this stress will create “unhealthy brain architecture.”

Dangers of 'prolonged' stress

Leading pediatricians and scientists recognize that this early brain development is crucial for all other childhood development. Addressing issues early, when the brain is still developing, is much easier than mopping up the impacts later on. Todd Grindal, past Research Fellow at the Harvard Center on the Developing Child, warns of the damage if an infant or toddler’s “stress response system” is “set permanently on high alert.”

According to Grindal, there is evidence that "prolonged activation of stress response hormones in early childhood can actually reduce neuroconnections in these important areas at exactly the time when children should be growing new ones.”

Professor Levitt agrees that the infant brain should not be exposed to sustained toxic stress.

“Brain architecture can be damaged,” he said. “Connections can be lost.”

Beyond the potential damage to the brain, years of research now illuminate other longer-term impacts from early toxic-stress exposure. Levitt warns that multiple adverse experiences can "increase risks long-term for cardiovascular disease, immune disorder, increased risk for cancer, increased risk for mental health disorders, and substance abuse risk goes way up.”

The AAP recommendations will encourage pediatricians to look for signs of toxic stress and make referrals to specialists. The recommendations follow last year's AAP policy statement on the pediatrician's role in identifying and treating infant toxic stress.

'Attuned parenting'

The recommendations will include simple strategies for pediatricians to talk to parents about ensuring healthy brain development in infants. Levitt calls it “attuned parenting” and uses a tennis metaphor to illustrate how simple it is to ensure “health brain architecture.”

“Children grow up in an environment of relationships,” said Levitt. An infant will do something and will have an “expectation of getting a response from whoever is in their environment. And that’s ‘serve and return’.”

Levitt adds there is no set of exercises parents should do to help an infant regulate stress. Attuned parenting, he said, comes naturally to most parents and simply involves “being close and warm and nurturing and looking directly into your child’s eyes.” Responding to a baby’s vocalizations or facial gestures is “fantastic for the developing brain,” said Levitt.